Neurocognitive Disorders Flashcards by Ahmed Alkhoufi

What are the diagnostic criteria / domains for neurocognitive decline? (6)

Decline in:

Language
Complex attention
Perceptual motor
Executive function
Learning and memory
Social cognition

-(LAPELS)

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What is the difference between major and minor cognitive decline?

Major = significant impairment

Minor = modest decline

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Dementia is unusual to see prior to what age?

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True or false: very few cases of dementia are reversible

True

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What is the most common cause of dementia?

Alzheimer’s disease

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What areas of the brain (lobes) are affected with AD?

Parietal and temporal lobes

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True or false: dementia is a normal part of aging

False

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What are the genes that are associated with AD?

Presenilin 1 and 2

amyloid precursor protein

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What is the gene that is associated with early onset AD?

ApoE4

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What is the gene that is protective against AD?

Apo E2

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True or false: early onset AD has a strong genetic component

True

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What is the natural h/o AD?

Gradual onset and progression

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What are the two major questions that are used to screen for AD?

lost in a well known area

- Cannot pay bills

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What is the neurotransmitter that is changed with AD?

Decreased ACh

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What are the histological findings of AD?

Neurofibrillary tangles
Neuritic plaques
Excess amyloid

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What is the average survival rate of AD?

8-10 years

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What is the function of the Tau proteins?

Maintaining neuronal function (microtubule associated proteins)

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What areas of the brain are particularly affected with AD?

Hippocampus

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What is Binswanger’s disease? Which part of the brain is usually affected?

Multi Infarct dementia that is usually subcortical, but progresses to cortical dementia

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What disease usually coexists with AD?

Vascular disease

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What is the second most common type of dementia?

Vascular disease

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What are the psychosis s/sx of lewy body dementia?

-Visual hallucinations/ delusions

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What are the s/sx of PD? (TRAP)

Tremor (resting)
Rigidity
Akinesia
Postural instability

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What is the treatment for lewy body disease? What should never be used?

Cholinesterase inhibitors

Never use antipsychotics

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What is Pick's disease?

Frontotemporal dementia--selective atrophy that involved the temporal and/or frontal lobes of the brain

When does frontotemporal dementia usually present, relative to AD?

50s as opposed to 70s for AD

What are the first s/sx of frontotemporal dementia?

Disinhibition and language problems

When do s/sx of CTE usually present?

8-10 years following repeated concussions

What are the usual s/sx of CTE?

- Disorientation, HA - Memory loss, poor judgement - Progressive dementia

What is the major difference between cortical and subcortical dementia?

Cortical = global loss | Subcortical is not

What are the four types of subcortical dementia?

- PD - MS - HD - Vascular disease

What is the inheritance pattern of HD?

What is the trinucleotide repeat in HD? What chromosome? What gene?

- CAG - Chromosome 4 - BDNF gene

What part of the brain is specifically affected with HD? What happens to neurotransmitters here?

Caudate loses ACh and GABA | "Hunt 4 an animal and put it in a CAGe"

What are the usual first s/sx of HD?

Depression, flat affect | Rapid speech

What is the classic triad of normal pressure hydrocephalus?

"Wacky, wobbly, and wet" - Confusion/delirium - Ataxic gait - Urinary incontinence

How do you diagnose NPH?

Brain scan and/or LP

What is the treatment for NPH?

VP Shunt (ventriculoperitoneal shunt)

What are the causes of static encephalopathy? (4)

- TBI - Hypoxic Brain injury - Korsakoff syndrome - Post infectious

What is the classic triad of Wernicke's encephalopathy?

- Delirium - ocular change - Gait disturbance

What is the key symptom of Wernicke's encephalopathy?

confabulation

What is Korsakoff syndrome?

- Memory impairment part of WK syndrome | - Marked short term memory loss, that are filled in with confabulations

What is the rash called with lyme disease?

Erythema migrans

What is the antibiotic of choice for lyme disease?

Doxycycline

What are the s/sx Creutzfeldt-Jakob disease? Onset?

- Middle or older age - Serious psychiatric disturbances - Tremors - Obvious abnormal EEG

What are the three major s/sx of HIV encephalopathy?

- Cognitive impairment - Anxiety, depression - Mania

What is the gene that is defective in Wilson's disease?

ATP7B

What are the features of delirium?

- Disturbed attention/awareness | - Fluctuating course

True or false: visual or tactile hallucinations are common with delirium

True

What are the two extremes of delirium?

Hyper or hypo arousability

What are the four major risk factors for delirium? Which gender?

- Advanced age - Nursing home placement - Pre-existing brain damage - Male

What type of infection commonly causes delirium in the elderly?

UTIs

Is it possible to have dementia and delirium at the same time?

Yes--very common

How do you differentiate dementia and delirium?

Have to know baseline

What is the top priority with treating delirium?

Identify cause and correct it

If there is a risk of sz with delirium, what drug is indicated? What is agitated?

``` Sz = Benzo Agitated = Haldol ```

What is the prognosis for delirium?

Usually clears within 1-2 weeks, but one year mortality = 50%

What is mild cognitive impairment?

an intermediate stage between the expected cognitive decline of normal aging and the more serious decline of dementia

What is the prognosis for mild cognitive impairment?

Many, but not all, will progress to major NC disorder

How do you work up dementia?

- h and p with collateral sources - CBC - B12 - Thyroid - CMP

What is the role of ApoE4 in screening for AD?

Not sensitive or specific enough

When is head imaging indicated for the workup of dementia? (2)

- Focal neurological signs | - Falls (anticoags)

Who determines decision making capacity?

Physician

What are the FDA approved treatment for Behavioral and psychological symptoms of dementia (BPSD)?

None-- all are off label

What should be the first-line treatment for dementia?

CBT

What are the seven major behavioral clusters of dementia? Which do not usually respond to medication?

- Explosive - Really bad Psychotic - Manic - Depressed - Anxious - **Confused** - **Oppositional** "COMRADE"

What is the role of antidepressants in the treatment for dementia?

- Depression/anxiety | - Sexually inappropriate

When are benzo indicated for dementia?

PRN anxiety or insomnia, but o/w should be avoided

There is a higher mortality rate in dementia patients, when they're taking what drugs?

Antipsychotics

What are the atypical antipsychotics? Which two are specifically indicated for elderly patients with dementia?

- Risperidone** - Olanzapine** - Quetiapine - Aripiprazole - Ziprasidone

When are antipsychotics indicated for dementia patients?

Psychotic, manic

What are the side effects of risperidone?

Less anticholinergic

What are the side effects of olanzapine?

Weight gain

What are the side effects of quetiapine?

Sedating, but less EPS

What are the side effects of ziprasidone?

QT prolongation

What is the benefit of aripiprazole compared to other antipsychotics?

Less metabolic risk

What is the anticonvulsant indicated for dementia patients? When is it indicated?

- Carbamazepine | - Manic or explosive episodes

What is the classic side effect of trazodone?

Trazo-bone

Which drugs in particular are scrutinized by state regulators in nursing homes?

- Sedative-hypnotics | - Antipsychotics

What are the two major pharmacological treatments for cognitive s/sx of dementia?

- Acetyl-cholinesterase inhibitors | - Memantine

What is the MOA and use for memantine?

- AD | - NMDA receptor blocker

What are the three major acetylcholinesterase inhibitors used for dementia?

- Donepezil - Rivastigmine - Galantamine

What is the MOA of donepezil?

Acetyl-cholinesterase inhibitor

What is the MOA of Rivastigmine?

Acetyl-cholinesterase inhibitor

What is the MOA of Galantamine?

Acetyl-cholinesterase inhibitor

Is alcohol a risk factor for the development of dementia?

Protective if not abused | Destructive if abused or used excessively

What is the TCA of choice for MDD with psychotic features? Why?

- Amoxapine | - Metabolite is a dopamine receptor blocker

Neurocognitive Disorders Flashcards

(87 cards)